What treatment do you recommend for patients with meralgia paresthetica?

I recommend the following:

• Weight loss.
• Better control of sugar if the patient is diabetic.
• Avoid wearing tight belts or clothing.
• Sleep on the other side.
• Rule out inguinal hernia or focal gynecologic problems.
• Consider using a Lidocaine patch or, if not covered by insurance, a cream.
• Nerve blocks in the inguinal area. Typically, after one or two injections, they will experience significant improvement.

I do not believe that long-term use of Gabapentin or similar medications with weight gain side effects is beneficial.

Furthermore, the patient does not require a nerve stimulator, and with a nerve block of the lateral femoral cutaneous nerve of the thigh, their condition is likely to improve.

I have treated at least 20-30 patients using t...

I was taught as a resident that meralgia paresthetica is caused by wearing a belt too tightly and that the patient should use suspenders to hold up his/her pants. Not surprisingly, it didn't help.

So now I:

1. Reassure the patient that meralgia paresthetica is an annoying but relatively benign entrapment of the lateral cutaneous nerve of the thigh and not lumbar radiculopathy requiring L-S MRI, EMG/NCV, orthopedic evaluation, etc. for a herniated disk.
2. Prescribe a trial of gabapentin 100 mg TID on rare occasions for symptomatic relief.

(Reference: Personal highly anecdotal clinical experience. Not peer-reviewed)

Weight loss and avoid compression of the lateral thigh especially when sitting. Avoid pressure on the pelvic brim.

I often suggest topical lidocaine patches to cover the area. This may provide relief for discomfort and keeps anything that might rub against it.

If conservative measures don’t apply or don’t help, then lateral femoral nerve decompression surgery is a good option to eliminate pain rather than using chronic pain medication and for recovery of sensation. This eliminates pressure on the nerve from structures pressing on it.

First, screen for and treat the most common comorbidities (obesity, diabetes, hypothyroidism).

For acute pain, 0.25% Marcaine injection to the Lat Fem Cut nerve as the ASIS - requires positioning supine with the hip slightly hyperextended, and of course thorough cleansing of the area.

For persistent pain, NSAIDs (NOT Gabapentin) are usually sufficient if the causes are properly identified and treated.

P.S. Gabapentin can cause weight gain because it increases appetite and causes water retention.

Thank you @ Dr. @Dr. First Last and Dr. @Dr. First Last,

In this particular scenario, the patient has severe intermittent debilitating pain, she has been trialed on gabapentin, and higher doses are not well tolerated. PM&R recommended a local implantation of a nerve stimulator.

First of all, meralgia paresthetica in my experience is numbness, not pain, so the recommendations to treat pain won't work. If the condition is not painful, nothing needs to be done. If the condition is painful, trying the recommendations to reduce pain may be of benefit.

Besides other measures, I frequently prescribe zonisamide or topiramate up to 100 mg BID to help with the neuralgic pain as these do not cause weight gain.